NCLEX-RN Pharmacology Neurological
System Part 1 Exam Questions &
Rationales
20 Original NGN-Style Practice
Questions
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 72-year-old woman is admitted to the neurology unit after
experiencing two generalized tonic-clonic seizures. Her medical
history includes hypertension and chronic kidney disease stage
3. The provider prescribes levetiracetam 500 mg IV every 12
hours. Assessment findings include BP 138/76 mm Hg, HR
82/min, RR 18/min, oxygen saturation 97% on room air, and
serum creatinine 2.0 mg/dL. The nurse reviews the medication
administration record before giving the first dose.
Question Stem
,Which nursing action is the highest priority before
administering levetiracetam?
A. Assess the patient's renal function and verify whether dosage
adjustment is needed.
B. Administer the medication rapidly over 1 minute to control
seizures quickly.
C. Encourage the patient to consume grapefruit juice with the
medication.
D. Hold the medication until an electroencephalogram (EEG) is
completed.
Correct Answer
Correct Answer: A. Assess the patient's renal function and
verify whether dosage adjustment is needed.
Detailed Rationale
Levetiracetam is primarily eliminated unchanged by the
kidneys. Because this patient has chronic kidney disease and an
elevated serum creatinine, the nurse should verify that the
prescribed dose is appropriate for the patient's renal function
before administration. Administering an excessive dose may
increase the risk of adverse effects such as excessive sedation,
dizziness, confusion, and behavioral changes. Although
levetiracetam is generally well tolerated and has fewer drug
,interactions than many older antiseizure medications, renal
dosing remains an essential medication safety consideration.
Option B is incorrect because IV levetiracetam should be
infused over the recommended time (typically at least 15
minutes), not rapidly, to reduce infusion-related reactions.
Option C is incorrect because grapefruit juice is not clinically
significant with levetiracetam and is not recommended as part
of medication administration.
Option D is incorrect because treatment of seizures should not
be delayed while awaiting diagnostic testing when a medication
has already been prescribed.
Nursing care includes monitoring seizure frequency, mental
status, behavioral changes, and renal function while reinforcing
medication adherence.
Learning Objectives
After completing this question, the learner should be able to:
• Identify medications requiring renal dosage adjustments.
• Prioritize assessment before administering antiseizure
medications.
• Monitor patients for adverse neurologic effects during
therapy.
Medication Safety Focus
, Monitoring
Question 2
Clinical Scenario
A 29-year-old woman is newly diagnosed with epilepsy. She has
been prescribed lamotrigine and is receiving discharge
education. She states that she plans to become pregnant within
the next year. Her vital signs are stable, and she has no current
complaints.
Question Stem
Which statement by the patient indicates the need for
additional teaching?
A. "I should report any skin rash to my healthcare provider
immediately."
B. "I will stop taking this medication as soon as I have been
seizure-free for one month."
C. "I should continue taking my medication exactly as
prescribed."
D. "I need to discuss pregnancy planning with my healthcare
provider."
Correct Answer
System Part 1 Exam Questions &
Rationales
20 Original NGN-Style Practice
Questions
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 72-year-old woman is admitted to the neurology unit after
experiencing two generalized tonic-clonic seizures. Her medical
history includes hypertension and chronic kidney disease stage
3. The provider prescribes levetiracetam 500 mg IV every 12
hours. Assessment findings include BP 138/76 mm Hg, HR
82/min, RR 18/min, oxygen saturation 97% on room air, and
serum creatinine 2.0 mg/dL. The nurse reviews the medication
administration record before giving the first dose.
Question Stem
,Which nursing action is the highest priority before
administering levetiracetam?
A. Assess the patient's renal function and verify whether dosage
adjustment is needed.
B. Administer the medication rapidly over 1 minute to control
seizures quickly.
C. Encourage the patient to consume grapefruit juice with the
medication.
D. Hold the medication until an electroencephalogram (EEG) is
completed.
Correct Answer
Correct Answer: A. Assess the patient's renal function and
verify whether dosage adjustment is needed.
Detailed Rationale
Levetiracetam is primarily eliminated unchanged by the
kidneys. Because this patient has chronic kidney disease and an
elevated serum creatinine, the nurse should verify that the
prescribed dose is appropriate for the patient's renal function
before administration. Administering an excessive dose may
increase the risk of adverse effects such as excessive sedation,
dizziness, confusion, and behavioral changes. Although
levetiracetam is generally well tolerated and has fewer drug
,interactions than many older antiseizure medications, renal
dosing remains an essential medication safety consideration.
Option B is incorrect because IV levetiracetam should be
infused over the recommended time (typically at least 15
minutes), not rapidly, to reduce infusion-related reactions.
Option C is incorrect because grapefruit juice is not clinically
significant with levetiracetam and is not recommended as part
of medication administration.
Option D is incorrect because treatment of seizures should not
be delayed while awaiting diagnostic testing when a medication
has already been prescribed.
Nursing care includes monitoring seizure frequency, mental
status, behavioral changes, and renal function while reinforcing
medication adherence.
Learning Objectives
After completing this question, the learner should be able to:
• Identify medications requiring renal dosage adjustments.
• Prioritize assessment before administering antiseizure
medications.
• Monitor patients for adverse neurologic effects during
therapy.
Medication Safety Focus
, Monitoring
Question 2
Clinical Scenario
A 29-year-old woman is newly diagnosed with epilepsy. She has
been prescribed lamotrigine and is receiving discharge
education. She states that she plans to become pregnant within
the next year. Her vital signs are stable, and she has no current
complaints.
Question Stem
Which statement by the patient indicates the need for
additional teaching?
A. "I should report any skin rash to my healthcare provider
immediately."
B. "I will stop taking this medication as soon as I have been
seizure-free for one month."
C. "I should continue taking my medication exactly as
prescribed."
D. "I need to discuss pregnancy planning with my healthcare
provider."
Correct Answer
